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Meningitis

Meningitis is inflammation of the thin tissue that surrounds the brain and spinal cord, called the meninges. There are several types of meningitis. The most common is viral meningitis, which you get when a virus enters the body through the nose or mouth and travels to the brain. Bacterial meningitis is rare, but can be deadly. It usually starts with bacteria that cause a cold-like infection. It can block blood vessels in the brain and lead to stroke and brain damage. It can also harm other organs.

Anyone can get meningitis, but it is more common in people whose bodies have trouble fighting infections. Meningitis can progress rapidly. You should seek medical care quickly if you have

  • A sudden fever
  • A severe headache
  • A stiff neck

Early treatment can help prevent serious problems, including death. Vaccines can prevent some of the bacterial infections that cause meningitis. Parents of adolescents and students living in college dorms should talk to a doctor about the vaccination.

Meningoencephalitis

meningoencephalitis is an inflammation of the brain. The usual cause is a viral infection, but bacteria can also cause it. Cases can range from mild to severe. For mild cases, you could have flu-like symptoms.

Serious cases can cause

  • Severe headache
  • Sudden fever
  • Drowsiness
  • Vomiting
  • Confusion
  • Seizures
  • Mild cases can cause

Flu-like symptoms

You may just need rest, plenty of fluids and a pain reliever. For severe cases, you might need to be hospitalized. The possibility for underdiagnosis and misdiagnosis for meningoencephalitis is highly possible noting that we have very few diagnostic tools for identifying its occurrence.

  • meningoencephalitis(Nemours Foundation)
  • Meningitis and meningoencephalitisFrom the National Institutes of Health (National Institute of Neurological Disorders and Stroke)

meningoencephalitis literally means an inflammation of the brain, but it usually refers to brain inflammation caused by a virus. Seeing a severe case of meningoencephalitis is a rare disease that only occurs in approximately 0.5 per 100,000 individuals - most commonly in children, the elderly, and people with weakened immune systems.

Although several thousand cases of meningoencephalitis (also called acute viral meningoencephalitis or aseptic meningoencephalitis) are reported to the Centers for Disease Control and Prevention (CDC) every year, experts suspect that many more may go unreported because the symptoms are mild.
Signs and Symptoms

Symptoms in milder cases of meningoencephalitis usually include:

  • fever
  • headache
  • poor appetite
  • loss of energy
  • just a general sick feeling

In more severe cases of meningoencephalitis, a person is more likely to experience high fever and any of a number of symptoms that relate to the central nervous system including:

  • severe headache
  • nausea and vomiting
  • stiff neck
  • confusion
  • disorientation
  • personality changes
  • convulsions (seizures)
  • problems with speech or hearing
  • hallucinations
  • memory loss
  • drowsiness
  • coma

It's harder to detect some of these symptoms in infants, but there are still some important signs to look for including:

  • vomiting
  • a full or bulging soft spot (fontanel)
  • crying that doesn't stop or that seems worse when an infant is picked up or handled in some way
  • body stiffness

Because meningoencephalitis can follow or accompany common viral illnesses, there are sometimes characteristic signs and symptoms of these illnesses beforehand. But often, the meningoencephalitis appears without warning.

Causes

Because meningoencephalitis can be caused by many types of germs, the infection can be spread in several different ways.

Influenza Type A and B viral infections are the most commnly identified cause for meningomeningoencephalitis. These infections, when occur and progress very quickly and be very serious.

Of the many different kinds of viruses that can cause meningoencephalitis, one of the most dangerous and the most common cause of meningoencephalitis is the herpes simplex virus (HSV). HSV is the same virus that causes cold sores around the mouth, but when it attacks the brain it may be fatal in as many as half of newborns who become infected and up to 28% of individuals after the newborn period. Identifying HSV meningoencephalitis is very rare. The 2 most common types are HSV 1 and HSV 2.

Results of a nationally representative study show that herpes infection is common in the United States. Nationwide, at least 45 million people ages 12 and older, or one out of five adolescents and adults, have had HSV infection. Over the past decade, the percent of Americans with genital herpes infection in the U.S. has decreased.

Meningoencephalitis can be a complication of Lyme disease transmitted by ticks, or of rabies spread by rabid animals.

Mosquitoes can also transmit the viruses for several types of meningoencephalitis, including West Nile meningoencephalitis, St. Louis meningoencephalitis, and Western Equine meningoencephalitis. Over the last several years in the United States, there's been concern about the spread of West Nile virus, which is transmitted to humans by mosquitoes that pick up the virus by biting infected birds.

Milder forms of meningomeningoencephalitis can follow or accompany common childhood illnesses, including measles, mumps, chickenpox, rubella (German measles), and mononucleosis. Viruses like chickenpox spread mostly via the fluids of the nose and throat, usually during a cough or sneeze.

Less commonly, meningoencephalitis can result from a bacterial infection, such as bacterial meningitis, or it may be a complication of other infectious diseases like syphilis. Certain parasites, like toxoplasmosis, can also cause meningoencephalitis in people with weakened immune systems.
Contagiousness

Brain inflammation itself is not contagious, but any of the various viruses that cause meningoencephalitis are highly infectious. Of course, just because a child gets a certain virus does not mean that he or she will develop meningoencephalitis. Still, to be safe, children should avoid contact with anyone who has meningoencephalitis.

Can meningitis or meningoencephalitis be prevented?

The best way to protect your child from meningitis or meningoencephalitis is to make sure he or she gets all the standard immunizations for children. These include shots for influenza Type A and B (Virus), measles, chickenpox, Haemophilus influenzae type B (Hib) disease, and pneumococcal infection.

It is important to understand that since the Flu is so common that to prevent severe complications the vast majority of the population must get a vaccination. Healthy parents, grandparents and school friends can pass a potentially lethal virus to a family member or friend that may not affect the healthy individual who passed the Flu virus. Factoid: Everyone should obtain a Flu immunization annually if we want to halt the occurrence of viral meningitis or meningoencephalitis.

Talk to your doctor about whether you or your child also needs the meningococcal vaccine, which is a shot to prevent bacterial meningitis. It is recommended for:

  • Adolescents ages 11 and 12.
  • Teens ages 13 to 18 who haven't had the shot yet. (They should get it as soon as possible.)

General Prevention measures:

Meningomeningoencephalitis cannot be prevented except to try to prevent the illnesses that may lead to it. meningoencephalitis that may be seen with common childhood illnesses like measles, mumps, and chickenpox can be largely prevented through proper immunization. Have your child immunized according to the immunization schedule recommended by your child's doctor. Children should also avoid contact with anyone who already has meningoencephalitis.

In areas where meningoencephalitis can be transmitted by insect bites, especially mosquitoes, children should:

  • Avoid being outside at dawn and dusk (when mosquitoes are most active).
  • Wear protective clothing like long sleeves and long pants.
  • Use insect repellent.

Also, all standing water around your home should be drained, including buckets, birdbaths, and flowerpots, because these are breeding grounds for mosquitoes.

Some things you can do to avoid tick bites:

  • Limit your child's contact with soil, leaves, and vegetation.
  • Have your child wear long-sleeved, light-colored shirts and long pants.
  • Check your child and your pets frequently for ticks.

Duration

For most forms of meningoencephalitis, the acute phase of the illness (when symptoms are the most severe) usually lasts up to a week. Full recovery can take much longer, often several weeks or months. In severe cases, it can result in death.
Diagnosis

Doctors currently have very few definitive diagnostic test that can give any certainty to the appropriate viral cause or initiate specific treatment due to the lack of accurate testing for viruses.

Doctors use several tests to diagnose meningoencephalitis, including:

  • imaging tests, such as computed tomography (CT) scans or magnetic resonance imaging (MRI), to check the brain for swelling, bleeding, or other abnormalities
  • electroencephalogram (EEG), which records the electrical signals in the brain, to check for abnormal brain waves
  • blood tests to confirm the presence of bacteria or viruses in the blood, and whether a person is producing antibodies (specific proteins that fight infection) in response to a germ
  • lumbar puncture, also known as a spinal tap, in which cerebrospinal fluid (the fluid that surrounds the brain and spinal cord) is checked for signs of infection

How is it treated?

Some children with very mild meningoencephalitis can be monitored at home, but most will need care in a hospital, usually in an intensive care unit. Doctors will carefully monitor their blood pressure, heart rate, and breathing, as well as their body fluids, to prevent further swelling of the brain.

Because antibiotics aren't effective against viruses, they aren't used to treat meningoencephalitis. However, antiviral drugs can be used to treat some forms of meningoencephalitis, especially the type caused by the herpes simplex virus. Corticosteroids may also be used in some cases to reduce brain swelling. If a child is having seizures, anticonvulsants may also be given.

Treatment depends on the cause. See your doctor right away if you or your child has symptoms, because bacterial meningitis can be deadly if not treated right away.

Bacterial meningitis is treated in a hospital. You or your child will get antibiotics. And you will be watched carefully to prevent serious problems such as hearing loss, seizures, or brain damage.

But viral meningitis is more common, and most people with this form of the illness get better in about 2 weeks. With mild cases, you may only need home treatment. Home treatment includes drinking lots of fluids and taking medicine for fever and pain.

Known treatments for viral meningitis or meningoencephalitis could be Tamiflu if influenza is the viral infection. It is imperative that this medication be administered within the 1st 48 hours of symptoms, the sooner the better. This can likely reduce severe cases of meningitis or meningoencephalitis.

Treating cold sores aggressively with antiviral medications suchs as acyclovir (Zovirax), famcyclovir (Famvir) or penciclovir (Denavir)for a week duration at the earliest signs of a cold sore could also likely prevent the complication of meningitis or meningoencephalitis.

Over-the-counter (OTC) medications, like acetaminophen, can be used to treat fever and headaches.

Many people with meningoencephalitis make a full recovery or recovery with some disability. In a small percentage of cases, swelling of the brain can lead to permanent brain damage and lasting complications like learning disabilities, speech problems, memory loss, or lack of muscle control. Speech, physical, or occupational therapy may be necessary in these cases.

If the brain damage is severe, meningoencephalitis can lead to death. Infants younger than 1 year and adults older than 55 are at greatest risk of death from meningoencephalitis. The complication of seizures occurs in at least 50 % of cases and almost 100% of those cases are in preteen and teenager age children.
When to Call Your Child's Doctor

Call your child's doctor if your child has a high fever, especially if he or she also has a childhood illness (measles, mumps, chickenpox) or is recovering from one.

Seek immediate medical attention if your child has any of the following symptoms:

  • severe headache
  • convulsions (seizures)
  • stiff neck
  • inability to look at bright lights
  • double vision
  • difficulty walking
  • problems with speech or hearing
  • difficulty moving an arm or leg
  • loss of sensation anywhere in the body
  • sudden personality changes
  • problems with memory
  • extreme drowsiness or lethargy
  • loss of consciousness

If your infant has any of the following symptoms, seek immediate medical care:

  • high fever or any fever higher than 100.4 degrees Fahrenheit (38 degrees Celsius) in infants younger than 3 months of age
  • fullness or bulging in the soft spot
  • any stiffness
  • floppiness or decreased tone
  • lethargy
  • poor appetite or reduced feeding
  • vomiting
  • crying that won't stop

Bacterial meningitis and septicaemia can kill in hours

Meningitis and septicaemia can be hard to recognize at first.

Symptoms can appear in any order, but the first symptoms are usually fever, vomiting, headache and feeling unwell, just like in many mild illnesses.

The 'red flag' symptoms often appear earlier than meningitis symptoms like neck stiffness and dislike of light, and before the more serious symptoms

Meningococcal disease may progress very rapidly and has a mortality of up to 50% in the most severely ill cases. Early recognition, aggressive resuscitation, specialist advice and transfer to PICU can reduce this mortality to less than 5%.

Complications during illness with meningitis or meningoencephalitis may include:

* Prolonged fever. Fever caused by bacterial meningitis usually goes away after 3 to 6 days of treatment with antibiotics. Fever that continues after 6 days on antibiotics or that goes away and returns may mean that the antibiotic is not killing the bacteria. On rare occasions, fever is caused by other conditions, including reactions to medicines used to treat meningitis.

* Seizures. This complication can develop because of inflammation and swelling of the brain and tissues (meninges) surrounding the brain. Sometimes controlling seizures is difficult. This occurs in up to 50% of these cases. Factoid: Most epilepsy patients were not born with the disorder. Almost half of people with epilepsy suffered this as a complication related to a meningitis or meningoencephalitis infection. Preteen and teenage children are at the highest risk for developing status epilepticus, intractable seizures (seizures won't stop). This is a very serious complication that needs immediate medical attention.

* Syndrome of inappropriate antidiuretic hormone (SIADH). This complication of bacterial meningitis may develop 1 to 2 days after antibiotics have been started. SIADH causes large amounts of fluid to build up in the body. If SIADH is not treated, coma and death can occur.

Diabetes Insipidus is an abnormally high production of urine related to an injury to the pituatary gland during often related to increased pressures on the brain. This is an ominous sign.

* Disseminated intravascular coagulation (DIC). This condition causes changes in the blood. At first, the blood clots too quickly. Then it clots too slowly, causing bleeding within the skin and tissues. DIC is life-threatening.

* Acute respiratory distress syndrome. This is a serious condition that begins suddenly. Fluid builds up in the lungs and causes breathing failure.

Death can occur in severe cases.

VVV Research Foundation | © Copyright 2008



This website reflects the personal opinions of the author. Making decisions about your health and medical treatment must be made in conjuction with your own medical provider. The contents of this website are not to be construed as exhaustive or complete. Any omissions or oversights is unintentional.